Should compromised first permanent molar teeth in children be routinely removed? A health economics analysis.

OBJECTIVE: To evaluate the cost-effectiveness of retaining one or more compromised first permanent molars (cFPMs) affected by dental caries or enamel hypomineralization, compared to timely extraction, in children aged 8 years. METHODS: A Markov model was developed to simulate the lifetime of a cFPM. Two management strategies were compared: extraction facilitating spontaneous space closure or maintenance of teeth with restorations. Ten health states were utilized to capture long-term outcomes including various tooth restorations, prostheses or a retained gap at the cFPM site. Outcomes were expressed as Quality Adjusted Tooth-Years (QATYs). The model was informed by survey data on patient preferences for treatment outcomes and UK data on costs. Discounted costs and QATYs were calculated over 62 years. RESULTS: Regardless of the number of cFPMs, retaining cFPMs was more effective than early removal, generating an additional 2.3 QATYs per cFPM. Early removal of one or two cFPM under general anaesthetic (GA) was more expensive than retention and hence never cost-effective. Retaining a cFPM was more expensive than early removal under local anaesthesia or where four cFPMs were extracted under GA. In these cases, retaining cFPMs was cost-effective if a QATY was valued at £100 or £35, respectively. Results were robust to sensitivity analysis. CONCLUSION: Preserving a cFPM was more cost-effective than the early loss of one, or two cFPMs under GA. Preservation of four cFPMs was cost-effective if sufficient value was placed on a QATY. These findings can guide clinical practice on management of cFPMs alongside patient/payer values on maintaining teeth.

The dental health of cleft patients attending the 18-month-old clinic at a specialised cleft centre.

Background Cleft lip and/or palate (CLP) patients are at high risk of developing dental caries and show a greater prevalence of dental defects.Aims To establish if CLP patients who attended the 18-month clinic had local dentists, were complying with oral hygiene instruction and had stopped bottle-feeding as per guidelines.Design Data were collected retrospectively over a 24-month period in which a total of 62 records were assessed.Results Data analyses revealed that 42% of patients who attended the clinic were registered with a dentist. Fifty percent of patients had stopped bottle-feeding and 67% were brushing two or more times a day. Although all patients reviewed on the clinic were caries free, 57% presented with a dental anomaly (hypodontia, hypomineralisation or hypoplasia).Conclusion Despite CLP patients being at high risk for developing dental caries, results showed that significant proportions of parents/carers were not following national guidelines for prevention. This evaluation highlights that shared preventive support between primary care dentists and specialist cleft dentists is not being achieved in the majority of cases. It also recognises that parents of CLP patients are either not receiving, or are failing to implement, preventive care advice.